O co jde, kdo a proč by se měl o vyšetření zajímat ?

Na základě rozsáhlých  výzkumů v zahraničí, které byly již publikovány v rukopisech a souhrných článcích je možné konstatovat, že autismus je indukován infekčními antigeny, toxickými látkami a proteiny z potravy. Tak jako u mnoha systémových  onemocnění,  u dětí i dospělých,hrají  i v rozvoji  autismu, poruch autistického spektra,klíčovou  úlohu genetické faktory, faktory vnějšího prostředí včetně infektů, xenobiotik,proteinů z potravy a peptidů.Takzvané  vnější faktory ovlivnují genetické předpoklady, které vyústí v gastrointestinální, neurologické,biochemické a neuroimunologické abnormality, díky vyšetření opioidních peptidů v moči je možné tyto abnormality odhalit.

What is an opioid?

An opioid is a substance capable of binding to opioid receptors in the central nervous system. Opioids are classified into two main groups based on their origin:

1. Endogenous (Endo-): Produced naturally within the body, such as endorphins. These are further divided into subgroups.
2. Exogenous (Exo-): Introduced from outside the body, such as exorphins.

What Is a Peptide?

A peptide is a small protein composed of just a few building blocks knows as amino acids.

What Is an Opioid Peptide?

An opioid peptide is a small protein that can bind to opioid receptors in the brain. Because of its small molecular size it can easily cross the blood-brain barrier (which can be problematic as it reaches brain receptors) and is also easily excreted in urine. This allows for non-invasive testing through urine samples.

Avoiding the need for blood draws or even cerebrospinal fluid collection.

Opioid peptides in food

Opioid peptides are present in various dietary sources. These nutritional proteins and peptides including casein and its metabolite casomorphin. As well as gluten and its metabolite gluteomorphin can stimulate T-cells and induce peptide-specific T-cell responses. This may lead to the production of abnormal cytokine levels, causing inflammation, autoimmune reactions, and disruption of neuroimmune communication. Through opioid receptors in the brain, peripheral nerves, and gut. These peptides influence pain perception, stress management, learning, memory and the development of social skills. They also affect mood, digestion, respiration, and immunity.

Many children with autism are intolerant to grain and dairy proteins and peptides therefore eliminating these from the diet often leads to significant improvements in their condition.In our center, an increasing number of adults have reported relief after removing gluten and dairy from their diets. Noting improved energy and psychological well-being. This observation strongly suggests that the effects are much more than a dietary trend. Clinically, this aligns with laboratory findings in MS-like syndromes (multiple sclerosis). Researchers have observed that encephalitogenic T-cell responses against myelin-oligodendrocyte glycoprotein (MOG) can be modulated by immunological cross-reactivity with the extracellular domain of the milk protein butyrophilin (BTN).

Additionally, IgG, IgM, and IgA antibodies against nine neuron-specific antigens have been detected in the serum of children with autism. These antibodies bind to various encephalitogenic molecules. ELISA testing for IgG, IgA, and IgM against milk peptides can show values exceeding 0.30 in serum. In patients with celiac disease,

gluten ataxia, and later in autism, antibodies against different gliadin proteins have been identified.

Gluten sensitivity / Gluten ataxia

One of the most common manifestations of gluten sensitivity is a neurological disorder known as gluten ataxia. More than 33% of patients with neurological dysfunction and 90% of patients with dermatological symptoms associated with gluten sensitivity also have celiac disease. The remaining patients show serological markers of anti-gliadin antibodies and the HLA-DQ2 genetic predisposition, although biopsy may not confirm small intestine damage. Epidemiological studies involving 200 patients found gluten ataxia in 40% of idiopathic sporadic cerebellar degeneration cases. Biopsies revealed perivascular infiltrates of inflammatory cells targeting the cerebellum, along with Purkinje cell loss. This inflammatory response indicates that neurological impairment may be mediated by the immune system. Currently, researchers continue to evaluate serum reactivity in patients with gluten ataxia, celiac disease without neurological involvement, and healthy controls. High levels of IgA anti-gliadin antibodies were detected in my case as a mother and in both of my children in the USA in 2010. Tests for transglutaminase antibodies, HLA-DQ2 genetic testing, and biopsy were negative.

Testing for opioid peptides in urine is a non-invasive procedure, yet it frequently escapes attention.

In the Czech Republic, this area of research has not received the recognition or credibility it deserves. Unlike in many Western countries these findings are often dismissed or ridiculed. Despite appeals from parents of children with autism seeking answers and guidance, such testing is frequently regarded as unreliable and is largely ignored by the professional community.

When elevated levels of IgA anti-gliadin (IAG) antibodies are detected.It is important to take appropriate measures. While this test is not the only diagnostic tool available, it is certainly an essential first step in determining whether your children or loved ones may be experiencing underlying issues that go beyond behavioral challenges, emotional instability, anxiety, depression, autoimmune disorders, self-harm tendencies, altered sensory thresholds or other health struggles that are often ultimately labeled as idiopathic.

About HPLC method:

Vysokotlaká, vysokoúčinná kapalinová chromatografie je analytická/preparační metoda, která na základě povahy sledovaných látek, mobilní fáze a pevné fáze slouží k separaci,identifikaci a kvantifikování obsahu sledovaných látek v mobilní fázi. Tato metoda je používána více jak padesát let a je v současnosti jednou z hlavních analytických metod využívaných v široké oblasti vývoje.

Excitotoxins

There is a research-based evidence that excitotoxins can damage the brains of children, adolescents, and adults. In developing children, excitotoxins may disrupt the nervous system, contributing to learning difficulties and emotional instability throughout life. Common excitotoxins include.

Substances that may help mitigate excitotoxin-related damage include CoQ10, acetyl-L-carnitine, niacinamide, riboflavin, methylcobalamin, and thiamine

MSG

Other names for MSG include hydrolyzed vegetable protein, sodium caseinate, calcium caseinate, and textured protein.

For those with an allergic reaction to MSG, supplementation with vitamins B6 and B12, magnesium, taurine, and digestive enzymes may be beneficial.

Aspartame and other artificial sweeteners

Aspartame has been linked to approximately 75% of reported allergic reactions, many of which are severe, including convulsions, seizures, and, in rare cases, death. Documented symptoms include: migraines, dizziness, fatigue, cramps, nausea, epileptic seizures, numbness, depression, eczema, irritability, insomnia, hearing loss, respiratory issues, memory loss, poor concentration, panic attacks, loss of appetite, slurred speech, and joint pain.Composition of aspartame: Phenylalanine 50%, Aspartic Acid 40%, Methanol 10%.

Arsenic

Arsenic is found in rice and rice milk and is commonly used in herbicides and pesticides. It is classified as a Group 1 carcinogen.
To reduce exposure, choose organic or non-genetically modified rice.

Nitrates and Nitrites

Avoid processed meats such as sausages and other cured products, as they may contain high levels of nitrates and nitrites.

Sulfites

Children and adults with asthma should avoid sulfites which may appear under names such as sulfur dioxide, potassium bisulfite, potassium metabisulfite and sodium sulfite. Reactions can include throat swelling, sneezing, rapid heartbeat, pallor, diarrhea, vomiting, collapse and breathing difficulties. Sulfites are commonly found in foods such as guacamole, canned and fermented vegetables and fruits, molasses, and certain wines.

Soy

Many artificial colorings are carcinogenic. Research also demonstrates that they can cause hyperactivity in children.

Artificial Colorings

Many artificial colorings are carcinogenic. Research also demonstrates that they can cause hyperactivity in children.

Preservatives

BHA, BHT, and TBHQ are among the most concerning preservatives. They are commonly used in packaged foods and fast food to prevent oil rancidity, and are widely present in both food and non-food products.

Fluoride

Fluoride is a neurotoxin and should be avoided, especially in children. It is commonly found in toothpaste.

Chlorine

Do not drink chlorinated tap water. Use a high-quality water filter or at least a filtration pitcher. Children with autism spectrum disorders (ASD) may have phenol-sulfur-transferase (PST) issues, and exposure to chlorine can worsen biochemical processes and behavioral symptoms after swimming in chlorinated pools. Chlorine is a toxin that impacts the entire body, particularly the immune system and liver.

Acetaminophen

Acetaminophen can block and impair liver detoxification pathways. For children with ASD, if medication is necessary, ibuprofen is a safer alternative.

Amalgam fillings

Amalgam fillings can cause numerous health issues and, like aluminum, have been linked to ADD.

Microwave ovens

Avoid using microwave ovens. They emit harmful radiation and can destroy nutrients in food, making even otherwise healthy meals less beneficial after heating.

Geopathic zones

Have geopathic zones measured and neutralized in your living and working spaces. Turn off Wi-Fi and other electronic devices, as they contribute to electrosmog which can inhibit melatonin production.

Teflon

Avoid cooking on teflon-coated cookware. When heated to certain temperatures teflon releases fumes that can be ingested and may lead to neurological problems.

Other harmful substances

• Talc / Talcum powder – carcinogenic; associated with ovarian cancer
• Sodium lauryl sulfate (SLS) – highly toxic; found in shampoos, soaps, and toothpaste
• Titanium dioxide – carcinogenic
• Triethanolamine (TEA) & Diethanolamine (DEA) – can form carcinogenic nitrosamines
• Lanolin – natural substance, often contaminated with pesticides like DDT
• Dioxanes – highly toxic chemicals
• Saccharin – carcinogenic
• Formaldehyde – toxic and carcinogenic
• Propylene Glycol – carcinogenic

Chocolate, cookies, chips, sweets, yogurt, hot dogs, fries… autism and diet. And one day, it all starts to click. As a mother of a child on the autism spectrum, you eventually reach an inevitable realization: autism and diet are deeply interconnected and the right diet plays a truly crucial role in your child’s development. Simply put, if dietary adjustments are not implemented, progress can be severely limited.

Picky eating, diarrhea, constipation, nausea or even food aversion, eczema, asthma… does this sound familiar? Add speech delays and limitations, atypical social behaviors and sensory processing challenges. And to top it all off sleep difficulties and insomnia often follow. These are just a few of the issues parents commonly report when describing their children.

Sleep problems, in particular, are a frequent concern. While this picture may seem grim, research repeatedly shows that introducing a proper diet can significantly reduce and in some cases completely eliminate these symptoms. The benefits extend beyond these challenges, positively affecting a wide range of health issues. Parent testimonies consistently confirm these findings. Yet, I am continually surprised by how many parents are hesitant or even indifferent to try this non-invasive intervention for their children. Let me reassure you: concerns and reluctance about implementing dietary changes are far outweighed by the potential benefits for your child’s health and development. Through my own experience with my children and my work advising other parents of children with autism, I have dedicated myself to teaching families about the importance of this diet and how to implement it successfully. The results are remarkable.Of course, making any change is never easy.Especially for children who rely heavily on routines and repetitive behaviors for a sense of security. As a mother of a nearly seven-year-old son and a four-year-old daughter on the autism spectrum, both following the GFSFCF diet for approximately four and a half years. I would like to share practical and highly valuable strategies to achieve success in dietary interventions for autistic children.

1. First of all take a deep breath, exhale slowly and relax. Improving your child’s health is not a matter of days. it is a process that takes time and continues to evolve. Remember this, especially during moments when you feel close to giving up.
2. With so many diets and approaches marketed as effective or supportive it’s natural for parents to feel overwhelmed and unsure where to start. If you are uncertain which diet is best for your child, a safe starting point is the GFCFSF diet: Gluten-Free (GF), Casein-Free (CF), and Soy-Free (SF). This dietary foundation can produce noticeable results relatively quickly.
3. Read all available information about the GFCFSF diet. Implementing dietary changes is like preparing for battle to win a war. Learn everything you can about your “opponent”: AUTISM. Research and plan the best strategies to address it: DIET. Finally, arm yourself with the tools needed for victory: healthy, nutritious GFCFSF foods. Once prepared, you are ready to begin.
4. Be strict and consistent. The diet must be followed 100% of the time. Even a small deviation can have negative effects. You are your child’s strongest advocate. Ensure anyone who comes into contact with your child understands that they may only eat the foods provided from home. Always bring meals with you in a cooler or packed lunch. Ensure that at school, daycare or other frequently visited locations, appropriate meals or substitutes are available. Avoid unnecessary explanations or debates; your priority is consistency.
5. Keep a daily journal. Whether electronic or in a notebook, record everything your child eats and note any changes in behavior, improvements in digestion, eye contact, or any other observations you consider important. Do not rely solely on memory; detailed records can help identify foods to eliminate and provide a permanent record of your child’s health progress and well-being.
6. Connect with other parents following the same path. Share experiences, challenges, and successes. Collaborate with professionals to support your efforts. Remember, the diet is part of life, not life itself.

When implemented correctly, it can dramatically improve not only your child’s health but also the overall quality of life for the entire family. A proper dietary intervention can even help avoid the use of psychotropic medications. Following these six key steps will help your child feel better and more engaged with the world around them.

Do not confuse this with “miracle diets” or “magic pills” claiming to cure autism. As no such thing exists. The only effective path is a long-term, professional, and individualized approach tailored to the unique needs of each child. In close collaboration with parents, we adjust the diet for children with autism to optimize health outcomes.Step-by-step lifestyle changes can also lead to a reduction in certain autistic behaviors. Nutritional guidance is complementary. It does not replace therapy, medical care, or diagnosis.

The first and most important consideration for a newborn is nutrition. After your baby is born, there is no greater gift than breastfeeding. From the very first moments, it is crucial to place your baby at the breast and begin nursing immediately. During the first few days, your baby receives colostrum, the first milk, which is nutrient-dense and packed with antibodies, providing the best possible start in life.If, for any reason, you are unable to breastfeed, seek out a wet nurse or milk donor. Ideally, plan ahead with the hospital where you will give birth. You may need 3/4 donors to ensure a sufficient supply of milk for your baby. This effort is invaluable. Even supplementing formula with colostrum is better than formula alone. Even the smallest amount of colostrum can have a profound impact on your baby’s health and long-term development. Commercial formula cannot match the quality and benefits of mother’s milk. If no alternative is available, no wet nurse or milk donor, use formula. However supplement every feeding with high-quality probiotics from birth. These should be live bacteria, not those already present in standard formula.

Introducing Solid Foods: 4-6 Months

For formula-fed babies, solid foods can be introduced gradually from around 4 months. Breastfed babies generally start solids around 6 months, unless the baby is exceptionally hungry. Introduce one new food at a time, in very small amounts per day. The majority of nutrition should still come from breast milk or formula supplemented with probiotics. Ensure that the probiotics are live strains, not those naturally present in formula.

Week 1: Introducing broth

Begin with a meat-based broth. To make a strong, nutrient-rich broth, you need a piece of meat and bones. Do not add salt or any other ingredients. Place the meat and bones in a pot (not a pressure cooker) and simmer gently for 2-3 hours. Do not remove the fat, as this is what your baby needs. When serving you may add a small amount of homemade, unpasteurized yogurt. If you are concerned about bacteria, substitute probiotics instead of yogurt. Offer the broth to your baby before breastfeeding, using nursing as a reward. Feeding guideline: Start with 1-2 teaspoons of broth mixed with ½ teaspoon of yogurt or probiotics, then breastfeed. Gradually increase the amount as your baby accepts it. Avoid all commercial broths and bouillon cubes, which contain ingredients that may be harmful to your baby. You may also offer 1-2 teaspoons of freshly pressed vegetable juice (e.g., carrot) mixed with small amounts of green cabbage, root celery or lettuce, diluted with lukewarm water between meals. Do not use store-bought juices. Freshly pressed juices should be consumed within about 30 minutes for maximum benefit.

Week 2: Introducing vegetable soups

Continue the same approach as Week 1 and start preparing vegetable soups using peeled, well-cooked vegetables with no seeds or cores, pureed until smooth. Cook the vegetables in your homemade broth without salt or other additives. Use non-starchy vegetables only (avoid eggplant, potatoes, parsnips, and sweet potatoes). Suitable starter vegetables include carrot, pumpkin, zucchini, leek, onion, garlic, broccoli, and cauliflower. Cook until soft, let cool, and then puree.Add a small amount of healthy fat each day, rotating different sources: 1 teaspoon organic, unrefined coconut oil 1 teaspoon cold-pressed, extra-virgin oil 5 drops cod liver oil 1 teaspoon unsalted, clarified butter (ghee) 1 teaspoon unsalted, unpasteurized butter Offer a variety of fats daily to ensure nutritional diversity. When serving the pureed vegetables with fat, you may also add a small amount of homemade yogurt or probiotics. Start with a thinner consistency and gradually thicken the food as your baby becomes accustomed to solids.

Week 3: Introducing cooked meat

Continue as in Weeks 1 and 2. Begin introducing pureed, well-cooked meat (simmered in water for a long time, without salt). Add the pureed meat to vegetable soups and purées. Start with organic chicken, free from antibiotics or painkillers. Begin with 1 teaspoon and gradually increase the portion. Include broth and meat from various parts of the chicken, including the skin, breast, and other fatty sections, as these are nutritionally essential for your baby. After chicken, gradually introduce other types of meat, preferably those with bones and fatty cuts. The approach is to replace formula with these new foods: broth, pureed vegetables, and pureed meat. If you are breastfeeding, alternate these meals with nursing sessions. After each meal, allow the baby to nurse for comfort and additional nutrition. Increase homemade yogurt to 1-2 teaspoons after meals. Gradually introduce ripe avocado, starting with 1 teaspoon mixed into pureed vegetables and increasing over time. Also, gradually increase the amount of freshly pressed vegetable juices, such as carrot, kale or other suitable vegetables.

Weeks 4-5: Egg Yolks and Fruit

Continue everything from the previous weeks. Begin adding raw egg yolk from home-raised eggs into pureed vegetable soups, starting with ¼ teaspoon per day and slowly increasing. Monitor your baby for any reactions, such as changes in skin or stool. If tolerated, gradually increase to one egg yolk per day mixed into the soup. Once all introduced foods are well tolerated, you can start apple purée. Peel, cook, and puree the apples. Add a small amount of ghí, coconut oil, or butter to enrich the purée. Begin with 1 teaspoon and gradually increase the portion. When reheating food, use a stovetop, never a microwave. Microwaving not only destroys nutrients and beneficial components but also alters the food’s structure. Over time, transition from ghí to unsalted, unpasteurized butter for daily use.

Week 6-7

Continue all previously introduced foods. Increase homemade, unpasteurized yogurt to 3 teaspoons with each meal. At this stage, yogurt can also be added to vegetable juices or mixed into drinks. If your baby tolerates raw egg yolks, gradually increase the amount to two yolks per day, adding them to soups. If you choose to serve meat broth in a bottle, mix it with the yolk at this stage. Gradually increase the amount of meat in your baby’s meals, focusing on cuts with gelatinous parts around cartilage and bones, all thoroughly cooked in water. Avoid formula or other synthetic milk substitutes. If breastfeeding, continue as usual.

Months 8-9

Continue all previously introduced foods. From the eighth month, begin incorporating vegetable and nut patties made from: Zucchini (green or yellow) Various types of pumpkin or fall vegetables Egg yolk Nut butters (almond or hazelnut) Start with one patty per day and gradually increase the amount. Cook the patties on the stovetop using clarified butter (ghee), coconut oil, or any animal fat you have prepared yourself (e.g., rendered from duck, goose, or pork belly). Increase the amount of freshly pressed vegetable juices. You may add whey, homemade yogurt, or probiotics. Introduce one fresh apple into the vegetable juices. Begin adding raw vegetables to the diet, starting with leafy greens such as lettuce and peeled, deseeded cucumber. Puree these and mix into cooked vegetable purées or soups. Introduce them gradually, in small teaspoons, monitoring your baby for tolerance-checking stool, digestion, and skin reactions. Once these initial vegetables are well tolerated, introduce additional raw vegetables one at a time, such as carrot, celery, or soft cabbage, always pureed. Your baby may also begin to consume homemade sauerkraut juice, starting with 1 teaspoon per day and gradually increasing. This juice can be added to soups or mixed vegetable purées. Ideally, aim for a final amount of 1 teaspoon per meal, ensuring consistent exposure and digestive benefit.

Month 10 and Beyond

Continue all previously introduced foods. From the tenth month, you can begin introducing softly scrambled eggs (omelets) prepared with plenty of unpasteurized butter, coconut oil, ghee, or other animal fats such as duck, goose, or rendered pork fat that you have prepared yourself. Serve eggs alongside avocado or vegetables. Offer your baby peeled, raw apples and try ripe bananas (with slightly brown-skinned spots). Fruit should be served between meals as a snack, never alongside meat. Introduce homemade cottage cheese (made from your homemade yogurt). Start with 1 teaspoon and, if tolerated, gradually increase the portion. How to make homemade cottage cheese from yogurt: Place your container of yogurt into a bowl of hot water until it separates into firmer curds and whey. Line a strainer or colander with a cheesecloth, pour in the yogurt, tie the ends into a bundle, and hang to drip for about 8 hours (overnight works best). This cottage cheese, similar to fresh farmer’s cheese, can be added to meals or used in desserts, mixed with honey or fruit. Once this cheese or curd is well tolerated in larger amounts, you may experiment with raw milk.

Important Considerations Nothing in this program is set in stone. You will need to adapt the plan according to your child’s tolerance for each food.

Key indicators of tolerance include: Stool consistency: Diarrhea or constipation signals the baby may not be ready for the new food. Remove it from the diet for 2–4 weeks, then reintroduce gradually, teaspoon by teaspoon. Skin reactions: Hives, rashes, or eczema flare-ups indicate the food is not yet tolerated. If your baby has a strong reaction to yogurt, do not introduce it. Instead, ferment the milk and reserve the whey, which contains far less milk protein and is easier to tolerate. Start with 1 teaspoon of whey, gradually increasing the amount. During this phase, supplement with high-quality probiotics. Once your baby tolerates half a cup of whey, you can try reintroducing homemade yogurt. If yogurt still isn’t tolerated, this may indicate milk protein intolerance or allergy, including lactose intolerance.Breastfeeding: You may continue breastfeeding up to 3 years of age. Claims that breast milk cannot meet a child’s nutritional needs are misleading; the body naturally adjusts the composition of breast milk according to the baby’s requirements. This advice refers specifically to breastfeeding itself, not the complementary diet your child consumes from 12 months onward.

Weaning from the breast

Weaning can happen naturally when your child decides to stop nursing or planned. If you plan weaning, avoid periods of other major changes, such as starting daycare, spending less time together, illness, or other stressors. Children are incredibly sensitive barometers of their environment; they quickly sense parental anxiety or stress. If your child is having trouble eating or tolerating new foods, continue breastfeeding if possible, as it supports nutrition and immunity. The weaning stage is brief cherish these moments while they last.

Beyond feeding: Daily needs

Apart from high-quality, appropriate nutrition, your child needs: Love and attention Daily outdoor walks Good sleep Nothing else is required—no vaccines, injections, unnecessary tests, or chemically-laden products.

Vaccines and Immunization

Refer to Dr. Natasha Campbell-McBride’s book, Gut and Psychology Syndrome. Children following a GAPS protocol should not be vaccinated until their immune system is strong and their communication and physical skills are well developed usually around ages 4-5. If you choose to vaccinate later: Ensure your child is absolutely healthy at the time of vaccination. Learn about all vaccine ingredients and discuss them with a qualified medical professional.Prefer single vaccines over combination vaccines. Environmental and Home Care Avoid all unnecessary chemical exposure. Infants do not require soaps or shampoos. Lukewarm water alone is sufficient. Soaps remove natural protective oils and dry out skin. Use coconut or olive oil for diaper areas. For household cleaning, use natural substances: Baking soda Vinegar Lemon juice in a spray bottle Olive oil During your child’s first year, avoid renovations, new carpets, or fresh paint as these release toxic compounds that may affect development. Other precautions: Avoid chlorinated pools, crowded malls and hospitals. No smoking near your child. Avoid strong perfumes. Protect the mattress with a plastic cover to prevent chemical and microbial exposure from urine interacting with mattress materials. Finally, consider all potential environmental toxins, including food additives, electromagnetic radiation, and other chemical exposures, and minimize your baby’s contact with them.

Dear Parents, These are the skills and behaviors that a 3 year old child was expected to demonstrate according to pediatric standards from the 1980s. This raises the question: what has changed in the past few decades? If your child does not yet meet these developmental milestones, it is important to pay attention. Of course, every child develops at their own pace and slight differences are normal. However we should not ignore our biological developmental expectations. Unfortunately, the reality is that concerns raised by parents who notice early developmental deviations and consult their pediatrician are often not fully addressed or taken seriously. If a child at age 3 is behind on milestones, parents may wait another year to give the child more time. Then there may be a delay in diagnosis, often another year. By age 5, uneven development is usually more apparent, gaps widen and valuable time is lost when targeted support could have made a difference. Your pediatrician or another specialist should listen to your concerns and guide you to the right professionals if you feel something may be off with your child’s development.

Gross Motor Skills

1. Walks and runs confidently
2. Avoids obstacles while moving
3. Alternates feet when climbing stairs
4. Can jump down from a step
5. Kicks, throw and catches a ball

Fine Motor Skills

1. Can build a tower of 9 blocks and a bridge using 3 blocks
2. Turns pages in a book one at a time
3. Can thread beads persistently
4. Draws vertical and horizontal lines, circles, and attempts simple shapes on request
5. Can fold paper, though not yet precisely following a model
6. Can draw a picture for a parent and fold it like a little “envelope”

Cognitive Development & Language

1. Can state their full name when asked
2. Recognizes and names animals and people in pictures and can describe what they are doing
3. Can identify two colors or match them to objects (may still confuse green and blue)
4. Has spatial awareness and understands simple instructions, e.g., “give the ball to Mommy,” “put it under the table”
5. Can recite a simple nursery rhyme

Behavior & Social Skills

1. Makes friends with adults easily
2. Enjoys playing with other children
3. Maintains personal hygiene
4. Imitates simple household tasks performed by adults
5. Helps with dressing, can unbutton and attempts to button clothing

https://www.nvic.org/

http://www.vaclib.org/basic/vacingredient.htm

http://www.whale.to/vaccines/koren.html